Survival After Secondary Prevention Implantable Cardioverter-Defibrillator Placement

Katz, David F.; Peterson, Pamela N.; Borne, Ryan T.; Betz, Jarrod; Al‐Khatib, Sana M.; Varosy, Paul D.; Wang, Yongfei; Hsu, Jonathan C.; Hoffmayer, Kurt S.; Kipp, Ryan; Hansen, Carolina Malta; Turakhia, Mintu P.

doi:10.1016/j.jacep.2016.06.001

Cited by 16 publications

(10 citation statements)

References 19 publications

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“…Therefore, the appropriateness of ICD in DCM patients for primary prevention has been broadly questioned 17 . On the other hand, approximately 10% of patients for secondary prevention died within 1 year since ICD implantation 23,24 . And in the long‐term follow‐up of 7 years, up to 28% of patients died without experiencing any appropriate ICD therapy 25 .…”

Section: Discussionmentioning

confidence: 99%

Nomogram predicting death and heart transplantation before appropriate ICD shock in dilated cardiomyopathy

et al. 2022

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Aims This study aimed to develop and validate a competing risk nomogram for predicting all‐cause mortality and heart transplantation (HT) before first appropriate shock in non‐ischaemic dilated cardiomyopathy (DCM) patients receiving implantable cardioverter‐defibrillators (ICD). Methods and results A total of 218 consecutive DCM patients implanted with ICD between 2010 and 2019 at our institution were retrospectively enrolled. Cox proportional hazards model was primarily built to identify variables associated with death and HT. Then, a Fine–Gray model, accounting for the appropriate shock as a competing risk, was constructed using these selected variables along with implantation indication (primary vs. secondary). Finally, a nomogram based on the Fine–Gray model was established to predict 1‐, 3‐, and 5‐year probabilities of all‐cause mortality and HT before first appropriate shock. The area under the receiver operating characteristic (ROC) curve (AUC), Harrell's C‐index, and calibration curves were used to evaluate and internally validate the performance of this model. The decision curve analysis was applied to assess its clinical utility. The 1‐, 3‐, and 5‐year cumulative incidence of all‐cause mortality and HT without former appropriate shock were 5.3% [95% confidence interval (CI) 2.9–9.9%], 16.6% (95% CI 11–25.0%), and 25.3% (95% CI 17.2–37.1%), respectively. Five variables including implantation indication, left ventricular end‐diastolic diameter, N‐terminal pro‐brain natriuretic peptide, angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker, and amiodarone treatment were independently associated with it (all P < 0.05) and were used for constructing the nomogram. The 1‐, 3‐, and 5‐year AUC of the nomogram were 0.83 (95% CI 0.73–0.94, P < 0.001), 0.84 (95% CI 0.75–0.93, P < 0.001), and 0.85 (95% CI 0.77–0.94, P < 0.001), respectively. The Harrell's C‐index was 0.788 (95% CI 0.697–0.877, P < 0.001; 0.762 for the optimism‐corrected C‐index), showing the good discriminative ability of the model. The calibration was acceptable (optimism‐corrected slope 0.896). Decision curve analysis identified our model was clinically useful within the entire range of potential treatment thresholds for ICD implantation. Three risk groups stratified by scores were significantly different between cumulative incidence curves (P < 0.001). The identified high‐risk group composed 17.9% of our population and did not derive long‐term benefit from ICD. Conclusions The proposed nomogram is a simple, useful risk stratification tool for selecting potential ICD recipients in DCM patients. It might facilitate the shared decision‐making between patients and clinicians.

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Section: Discussionmentioning

confidence: 99%

Nomogram predicting death and heart transplantation before appropriate ICD shock in dilated cardiomyopathy

et al. 2022

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“…Although we chose to include patients in the earlier period of the NCDR registry (2006)(2007)(2008) to have a population more comparable to the one in the AVID trial, our NCDR population is similar to a more contemporary NCDR population [14,15]. Due to the small sample size for outcomes analysis, it was not possible to present a formal comparison of outcomes between the trial and the registry population.…”

Section: Discussionmentioning

confidence: 99%

How Do Patients Receiving a Secondary Prevention ICD in Clinical Practice Compare with Patients Enrolled in the Antiarrhythmic Versus Implantable Defibrillator (AVID) Trial?

Cm¹,

Fa²,

Hellkamp³

et al. 2021

NAJM

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“…For example, in an evaluation of 46,685 patients enrolled in the National Cardiovascular Data Registry between 2006 and 2009, 1-year mortality was 10% and 2-year mortality 16.4% in patients undergoing ICD implantation. 15 Intriguingly, 2-year mortality rates were similar in patients qualifying on the basis of resuscitated cardiac arrest and VT when compared to those qualifying on the basis of syncope in the setting of structural heart disease, even though the latter group was an inclusion criterion in only 1 of the landmark randomized trials in this population (CIDS). 7 The concordance of mortality rates in this contemporary cohort compared to historic randomized trials is striking given the higher penetrance of factors that would be predicted to lower mortality, including goal-directed medical therapy (β-blockers, renin-angiotensin-aldosterone system antagonists), lower prevalence of ischemic heart disease, and more flexible ICD programming.…”

Section: Longitudinal Clinical Outcomes In Secondary Preventionmentioning

confidence: 95%

“…First, the epidemiology of sudden death has changed since the completion of landmark trials (AVID, CIDS, CASH), 4 , 6 , 7 with contemporary ICD recipients being older, less likely to have ischemic cardiomyopathy, and more likely to have symptomatic heart failure. 15 In a contemporary analysis of secondary prevention patients, 40% of patients had an LVEF >35% at the time of ICD implant, a population that derived no mortality benefit in a meta-analysis of the original landmark studies. 8 Importantly, when considering the survival benefit of ICD therapy, each of these shifting epidemiologic factors (older age, advanced heart failure, nonischemic cardiomyopathy, and nonsevere LV dysfunction) have each been linked to an increased risk of competing, nonarrhythmic mortality.…”

Section: Systems Of Care For Secondary Prevention Patients and Opportunities For The Futurementioning

confidence: 99%

Secondary prevention of sudden cardiac death

Chatterjee

Rea

2020

Heart Rhythm O2

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The prevention and treatment of sudden cardiac death (SCD) remains a significant public health challenge. For patients with a history of sudden death attributable to ventricular arrhythmia, implantable cardioverter-defibrillator (ICD) therapy is a mainstay of treatment, although these patients remain at high risk for recurrent ventricular arrhythmia and defibrillator therapies. In this review, we summarize landmark clinical trials evaluating the efficacy of ICD therapy in secondary prevention patients, review clinical outcomes including mode of death in survivors of SCD, and highlight the role for systematic diagnostic evaluation. We additionally discuss the invasive electrophysiological management of these patients, including ICD selection and programming as well as the role and timing of antiarrhythmic drug therapy and catheter ablation. Finally, we frame future challenges and needs to advance the care for secondary prevention patients.

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Survival After Secondary Prevention Implantable Cardioverter-Defibrillator Placement

Abstract: Nearly 9 of 10 patients receiving a secondary prevention ICD in clinical practice are alive 1 year after implantation. The risk of death varies by indication and is highest among patients who survive SCD or sustained VT in the first year after device implantation.

Cited by 16 publications

References 19 publications

Nomogram predicting death and heart transplantation before appropriate ICD shock in dilated cardiomyopathy

Nomogram predicting death and heart transplantation before appropriate ICD shock in dilated cardiomyopathy

How Do Patients Receiving a Secondary Prevention ICD in Clinical Practice Compare with Patients Enrolled in the Antiarrhythmic Versus Implantable Defibrillator (AVID) Trial?

Secondary prevention of sudden cardiac death

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